The Comprehensive ESRD Care initiative was designed to identify, test, and evaluate new ways to improve care for Medicare beneficiaries with End-Stage Renal Disease (ESRD). Through the Comprehensive ESRD Care initiative, CMS will partner with health care providers and suppliers to test the effectiveness of a new payment and service delivery model in providing beneficiaries with patient-centered, high-quality care.
Beneficiaries with ESRD have significant care needs. These beneficiaries constituted 1.3% of the Medicare population and accounted for an estimated 7.5% of Medicare spending, totaling over $20 billion in 2010. These high costs are often the result of underlying disease complications and multiple co-morbidities, which often lead to high rates of hospital admission and readmissions, as well as a mortality rate that is much higher than the general Medicare population. Because of these complex health needs, beneficiaries often require visits to multiple providers and follow multiple care plans, which can be challenging for beneficiaries if care is not coordinated. Through enhanced care coordination, these beneficiaries will have a more patient-centered care experience, which will ultimately, improve health outcomes.
Through this new initiative, CMS will partner with groups of health care providers and suppliers – ESRD Seamless Care Organizations (ESCOs) – to test and evaluate a new model of payment and care delivery specific to Medicare beneficiaries with ESRD. Participating ESCOs will be clinically and financially responsible for all care offered to a group of matched beneficiaries, not only dialysis care or care specifically related to a beneficiary’s ESRD.
In the Request for Applications that was published on February 4, 2013, the Centers for Medicare & Medicaid Services (CMS) required that applicants to the Comprehensive ESRD Care initiative have a minimum of 500 matched beneficiaries to be eligible for participation in the initiative. This number was selected to ensure a statistically accurate shared savings calculation.
After review of numerous feedback and suggestions from organizations interested in new models of ESRD care, CMS has lowered the minimum beneficiary threshold required for eligibility for all applicants from 500 to 350 matched beneficiaries. Due to this change, the minimum savings rate (MSR) in the risk phase-in payment track for non-Large Dialysis Organizations (LDO) will change from 4% to 4.75% for those non-LDO participants that have between 350 to 499 matched beneficiaries in performance years 1 and 2 in order to maintain the same level of accuracy in calculating shared savings or losses.
Eligibility and How to Apply
On February 03, 2013, CMS will begin accepting letters of intent for the Comprehensive ESRD Care Initiative. For more information, visit the application page.
- Fact Sheet: Comprehensive ESRD Care Initiative
- Request for Applications: Comprehensive ESRD Care Initiative (PDF)
- Total Medicare FFS ESRD Beneficiaries not aligned to Medicare ACOs by State (PDF) - This document lists the total number of Medicare FFS beneficiaries with ESRD residing in each state that have not been aligned to Medicare ACOs. The percentage indicates the proportion of non-aligned beneficiaries to the total of Medicare FFS beneficiaries with ESRD in the state.
- Tuesday, February 5, 2013 Open Door Forum: Comprehensive ESRD Care Initiative
- Tuesday, February 26, 2013 Open Door Forum #2: Comprehensive ESRD Care Initiative
- Wednesday, May 8, 2013 Webinar: Comprehensive ESRD Care Initiative – How to Apply
Questions about the Comprehensive ESRD Care Initiative application, or the initiative generally, can be sent to email@example.com.